Abstract:Objective To investigate the value of erythrocyte distribution width(RDW)in predicting readmission risk in patients with surgical aortic valve replacement(SAVR).Methods A total of 118 patients with severe aortic stenosis(AS)who received SAVR in hospital from January 2021 to June 2024 were selected as the study subjects.Fasting peripheral venous blood was collected from patients within 24h before SAVR,and RDW was detected by the principle of electrical impedance through the blood analyzer.The end point of the study was the readmission rate of SAVR patients after discharge.According to the read-mission status within 1 year,the patients were divided into readmission group and non-readmission group.Results A total of 19 patients(16.10%)were readmitted within 1 year,of whom 47.37%(9/19)were due to cardiovascular causes,and heart failure and arrhythmia were the most common readmission indications.RDW levels in readmitted patients were significantly higher than those in non-readmitted patients[17.20(14.00,17.70)%vs.14.00(13.05,16.45)%,Z=-4.695,P<0.001].Univariate Cox proportional hazard regression model showed that RDW was significantly associated with readmission risk of SAVR patients(P<0.05).Multivariate Cox regression analysis,after adjusting for other confounding factors,showed that RDW was an inde-pendent predictor of readmission risk in SAVR patients(P<0.05),with hazard ratios of 4.872(95%CI:1.337-17.753)and 4.536(95%CI:1.093-18.826),respectively.RCS curve fitting showed a linear relationship between RDW and the risk of readmitted within 1 year.When RDW>14.20%,the HR of readmitted within 1 year for SAVR patients was>1.During 1-year follow-up,patients with high RDW(≥14.20%)had a higher readmission rate than patients with low RDW(<14.20%)[91.53%(54/59)vs.31.91%(15/47)],and the difference was significant(P<0.05).Conclusion Preoperative RDW elevation was an independent predictor of readmission risk in patients with SAVR within 1 year of surgery.RDW monitoring may help physicians identify pa-tients at higher risk of readmission early,thereby optimizing postoperative management strategies and reducing readmission rates.

Abstract:Objective To compare time-related clinical outcomes between patients undergoing transcatheter aortic valve replacement(TAVR)with prophylactic mechanical circulatory support(pMCS)and emergency mechanical circulatory support(eMCS).Methods Patients who underwent TAVR with MCS at the department of cardiovascular surgery,First Affiliated Hos-pital of Air Force Medical University,between January 2020 and November 2023 were retrospectively included.Patients were divided into pMCS and eMCS groups,based on the MCS strategy.Perioperative and follow-up data were compared between the two groups.The primary endpoints were all-cause mortality within 30 days postoperatively,mortality from day 31 to 1 year,and all-cause mortality within 1 year postoperatively.Results A total of 83 patients were enrolled(pMCS group:n=59;eMCS group:n=24)..Preoperative NYHA functional class was Ⅲ/Ⅳ in both groups,and there was a significant improvement in car-diac function compared to baseline at 30 days and 1 year postoperatively(P<0.001).Compared to the eMCS group,the pMCS group demonstrated superior outcomes in the following:30-day mortality(1.7%vs.25.0%,P<0.001),mortality from 31-day to 1 year(5.2%vs.22.2%,P<0.001),all-cause mortality within 1 year(6.8%vs.41.7%,P<0.001),cardiovascular mortality(5.2%vs.29.2%,P<0.001),and rehospitalization for heart failure(10.3%vs.47.2%,P<0.001)were significantly lower in the pMCS group compared to the eMCS group(all P<0.001).Conclusion Both pMCS and eMCS can be utilized to stabilize hemody-namics and improve prognosis and cardiac function in TAVR patients experiencing circulatory instability.However,pMCS was associated with significantly better clinical outcomes compared to eMCS.

Abstract:During the surgical treatment of children with congenital heart disease,hypothermia is a common complica-tion.It may lead to serious problems such as hypoxia and acidosis,and even poses a threat to life.Therefore,it is of great signifi-cance to study how to alleviate the adverse effects(e.g.,complications)of hypothermia.The purpose of this study is to review the research progress on the influencing factors and intervention measures of perioperative hypothermia in children with congenital heart disease,aiming to provide a reference for reducing the incidence of perioperative hypothermia in these children in China.

Abstract:Objective To explore the predictive value of serum brain-derived neurotrophic factor(BDNF)and interleu-kin-8(IL-8)levels for postoperative cognitive impairment in patients with Stanford type A aortic dissection treated with extracor-poreal circulation surgery.Methods 52 patients with Stanford type A aortic dissection treated with extracorporeal circulation surgery from January 2023 to June 2024 were selected as the study subjects.They were divided into a postoperative cognitive dysfunction(POCD)group(12 cases)and a control group(40 cases)based on whether POCD occurred.Researchers collected venous blood samples from patients before surgery(T0),10 minutes after anesthesia induction(T1),immediately at the start of surgery(T2),5 minutes after circulatory arrest at the end of surgery(T3),24 hours after surgery(T4),48 hours after surgery(T5),and 72 hours after surgery(T6)to measure serum levels of BDNF and IL-8,and perform statistical analysis.Results At time T3,T4,and T5,the BDNF levels in the POCD group were significantly lower than those in the control group,and the serum IL-8 levels were significantly higher than those in the control group at time points T3 and T4,P<0.05.The incidence of POCD in patients with low levels of BDNF was significantly higher than that in patients with high levels of BDNF,and the incidence of POCD in patients with high levels of IL-8 was significantly higher than that in patients with low levels of IL-8,P<0.05.BDNF levels were significantly positively correlated with MMSE scores(r=0.683,P<0.001),while IL-8 levels were significantly neg-atively correlated with MMSE scores(r=-0.687,P<0.001).BDNF and IL-8 have diagnostic value for POCD(AUC=0.8813,95%CI:0.779-0.982,P<0.001);AUC=0.899,95%CI:0.813-0.985,P<0.001).The decrease in BDNF levels at T3 and T4 and the increase in IL-8 levels at T4 are independent risk factors for the occurrence of POCD.Conclusion BDNF levels decrease and IL-8 levels increase in postoperative POCD patients with Stanford type A aortic dissection under extracorporeal circulation.BDNF and IL-8 have a certain predictive effect on the occurrence of POCD.

Abstract:Objective To evaluate the in-vitro static adsorption efficacy of the CA330 cytokine adsorption column for commonly used antithrombotic drugs—cilostazol,indobufen,and warfarin.Methods An in-vitro static adsorption model sim-ulating extracorporeal circulations was established CA330 adsorption resin was incubated in bovine serum containing the three target drugs under constant-temperature oscillation at 32±1℃and 140±10 cycles/min.Samples were collected before adsorp-tion and at 0.5,1.0,1.5,2.0,2.5,3.0,4.0,5.0 and 6.0 hours post-adsorption initiation.Drug concentrations were measured by liquid chromatography-tandem mass spectrometry(LC-MS/MS).Adsorption rates were calculated and adsorption curves were plotted.Each experimental group was tested in duplicate,with results presented as mean values.Results In the control group,the plasma concentrations of all three drugs remained relatively stable over the 6 hours with no significant decline.With CA330 adsorption resin,the removal rates for cilostazol at 0.5,1.0,and 6.0 hours were 84.38%,92.43%,and 98.20%,respectively;for indobufen were 82.17%,85.30%,and 93.83%;and for warfarin were 44.40%,48.81%,and 67.34%.The two antiplatelet agents reached a plateau after 1 hour of adsorption,whereas warfarin adsorption was relatively slow but showed a gradual upward trend over the full 6 hours.Conclusion The CA330 demonstrated high adsorption efficacy for cilostazol and indobufen,achieving significant drug clearance within a short timeframe;it also exhibited a certain adsorption capacity for warfarin.Further animal experiments or clinical studies could be conducted to confirm its potential clinical application value.

Abstract:Extracorporeal life support(ECLS)is a critical therapeutic modality for managing patients with life-threat-ening conditions such as cardiogenic shock and acute respiratory distress syndrome(ARDS).However,its clinical application remains constrained by biocompatibility challenges at the blood-material interface.This review comprehensively examines recent advances in ECLS coating technologies,and systematically analyzies their molecular mechanisms and clinical implementation challenges.We critically evaluate the advantages and limitations of mainstream coating strategies,including heparinized coatings,phosphorylcholine-based polymers,and nitric oxide-releasing surfaces.Furthermore,we discuss emerging coating technologies,such as endothelial-mimicking coatings and novel ionic polymer composites.To date,only heparin and phosphorylcholine coat-ings have achieved widespread clinical adoption,while other coatings exhibit distinct limitations despite their potential benefits.Thus,most novel coating materials require further optimization through preclinical and clinical validation.Future research should prioritize the development of multifunctional composite coatings that integrate nanotechnology and biomimetic designs to en-hance long-term hemocompatibility and mitigate inflammatory responses in ECLS systems.

Abstract:Mitral valve disease is a common heart valve disease,with mitral regurgitation(MR)being the most prevalent.Its incidence continues to rise amid an aging population.Traditional surgical interventions are associated with significant trauma and high risk,limiting their applicability in elderly patients or those with comorbidities.In recent years,Transcatheter mitral valve intervention(TAVI)have advanced rapidly,emerging as a critical treatment strategy.However,due to the complex patho-logical mechanisms of MR,precise diagnosis and prognostic evaluation are essential for formulating surgical plans.Breakthrough in artificial intelligence(AI)technology have revolutionized the diagnosis and management of MR.This article systematically re-views the latest applications of AI in MR Diagnosis,prognosis assessment and treatment of MR,and discusses future directions,providing insights for clinical practice and technological innovation.

Abstract:Stanford type A aortic dissection is a cardiovascular emergency with a high mortality rate.Its high-risk nature drives the continuous exploration of safer and more effective treatment strategies.For a long time,open surgery has been re-garded as the"gold standard"for treatment.With advancements in technology and equipment,surgical approaches have become increasingly diverse,leading to significantly improved success rates and markedly decreased mortality.Despite these significant advances,there is still no universally accepted optimal treatment strategy.This article reviews several commonly employed surgi-cal methods for acute type A aortic dissection internationally,analyzes their current applications,clinical outcomes,and existing challenges,and discusses future research directions.

Abstract:Objective This study aims to compare the effects of aspirin combined with clopidogrel(AC)versus aspirin combined with ticagrelor(AT)on great saphenous veins(GSVs)graft patency and the occurrence of adverse events at 4 years post coronary artery bypass grafting(CABG)on the basis of previous work,and to explore an optimal dual antiplatelet thera-py(DAPT)intensification strategy for Chinese patients after CABG.Methods Patients who successfully underwent elective CABG were randomized into AC group or AT groups.DAPT was initiated within 6 hours postoperatively according to the as-signed group.After one year,both groups were switched to single antiplatelet therapy with aspirin for long-term maintenance treatment.At 4 years post-CABG,GSV graft patency was assessed using 64-slice multidetector computed tomography angiogra-phy.The incidences of major adverse cardiovascular events(MACEs)and bleeding events were also recorded during follow-up.Results Among the 216 patients,3 died,and the remaining 213 patients completed the 4-year follow-up.The GSV graft paten-cy rate was 81.4%in the AC group,which was lower than that in the AT group(87.2%);however,this difference was not statis-tically significant(P>0.05).During the 4-year follow-up,21 MACEs and 55 bleeding events were documented.However,there was no statistically significant difference in the incidence of MACEs and bleeding events between two groups(P>0.05).Con-clusion Integrating the current 4-year follow-up data with our previous findings at 1 and 3 years post-CABG,although there is still no statistically significant difference in the GSV patency rate between the two DAPT intensive treatments,the difference is gradually widening.

Abstract:Objective This study aimed to investigate the dynamic changes in bioelectrical impedance phase angle(PhA)during the peri-cardiopulmonary bypass(CPB)period and its predictive value for ICU length of stay(LOS)following cardiac surgery.Methods Sixty patients undergoing CPB cardiac surgery between May and July 2023 were prospectively en-rolled.Whole-body and segmental PhA and edema index(EI)were measured using a multifrequency bioelectrical impedance analyzer(InBody S10)pre-CPB(post-anesthesia)and post-CPB.Patients were stratified into low-PhA(≤5.85°,n=30)and high-PhA(>5.85°,n=30)groups based on preoperative PhA median.Intergroup comparisons of baseline characteristics,intra-operative parameters,and clinical outcomes were performed.Linear regression identified independent predictors of ICU LOS.Results Post-CPB PhA decreased significantly compared with pre-CPB values(5.46°±1.16° vs.5.85°±1.05°,P=0.0035),with elevated upper-limb EI(P<0.05).The low PhA group exhibited poorer baseline status:lower BMI(21.34±3.47 kg/m2 vs.23.80±3.12 kg/m2),reduced preoperative albumin(36.93±3.35 g/L vs.39.63±4.25 g/L),and higher APACHEⅡ scores(7.70±4.16 vs.4.93±2.18)(all P<0.01).This group required higher intraoperative RBC transfusion[3.2(2.0-4.0)U vs.2.0(0.0-2.9)U,P=0.029],prolonged mechanical ventilation[10.8(7.2-21.5)h vs.7.5(5.0-10.0)h],and extended ICU LOS[32.0(21.2-67.0)h vs.21.0(19.2-24.0)h](all P<0.05).Linear regression identified preoperative PhA(β=-39.48,95%CI:-68.05 to-10.92,P=0.009),intraoperative fluid balance(β=0.02,95%CI:0.01-0.04,P=0.047),and mechanical ventilation du-ration(β=0.90,95%CI:0.72-1.09,P<0.001)as independent predictors of ICU LOS.Each 1° increase in preoperative PhA was associated with a reduction in ICU LOS of 39.48 hours.Conclusion Significant reduction in PhA and increased upper-limb hy-dration during CPB suggest CPB-induced cellular membrane dysfunction and regional fluid redistribution.Preoperative low PhA independently predicts prolonged postoperative ICU LOS.Segmental bioelectrical impedance analysis of the upper limbs may serve as a targeted monitoring metric for goal-directed fluid management during CPB.

Abstract:Systemic inflammatory response syndrome(SIRS)long with disruptions in pharmacokinetics(PK)and phar-macodynamics(PD)induced by extracorporeal circulation(ECC)represents a significant contributor to postoperative compli-cations following cardiac surgery.In recent years,blood adsorption technology has demonstrated considerable potential in im-proving postoperative outcomes by clearing inflammatory mediators and toxic substances.However,its unintended elimination of therapeutic drugs has sparked widespread debate.This review systematically examines the mechanisms of adsorption devices,summarizes their dynamic impacts on drug concentrations,and analyzes clinical challenges and controversies.This review aims to clarify the"double-edged sword"effects of adsorption technology,providing a theoretical foundation for individualized drug management in cardiac surgery,and advocating for a paradigm shift from"broad-spectrum inflammatory control"toward"preci-sion therapeutic strategies".

Abstract:Objective To investigate the clinical outcomes and influencing factors of extracorporeal membrane oxygen-ation(ECMO)support in pediatric patients with circulatory failure.Methods A retrospective analysis was performed on 52 children who received ECMO support for circulatory failure at the Children's Hospital of Soochow University between Decem-ber 2017 to May 2025.Patients were divided into survival and death groups according to hospital discharge outcomes.Baseline characteristics,ECMO management strategies,and complications were compared between the two groups,and long-term fol-low-up was conducted among survivors.Results The successful weaning rate from ECMO was 69.2%(36/52),the hospital sur-vival rate was 51.9%(27/52),and the one-year survival rate was 42.3%(22/52).The proportions of patients receiving extracor-poreal cardiopulmonary resuscitation(ECPR)and renal replacement therapy were significantly higher in the death group than in the survival group(56.0%vs.14.8%,P=0.005;76.0%vs.40.7%,P=0.022).Multivariate logistic regression identified ECPR as an independent risk factor for in-hospital mortality(OR=0.163,95%CI:0.038-0.703,P=0.015),while renal replacement therapy showed a trend toward an increased risk of death(P=0.068).During follow-up,primary disease-related problems were the lead-ing cause of long-term morbidity(33.3%),followed by neurological sequelae(25.9%)and moderate exercise intolerance(7.4%).Conclusion ECPR is an independent risk factor for poor outcomes in pediatric patients supported with ECMO,whereas the need for renal replacement therapy indicates critical illness and is associated with adverse prognosis.Primary disease exerts a sig-nificant impact on long-term outcomes,underscoring the importance of targeted management and structured long-term follow-up to improve overall prognosis.

Abstract:Objective To identify prognostic risk factors and construct a predictive model for weaning outcomes in cardiac surgery patients receiving postoperative extracorporeal membrane oxygenation(ECMO).Methods A retrospective co-hort study included 65 patients who underwent cardiac surgery and received ECMO treatment after surgery in our hospital from October 2019 to September 2024.According to the weaning situation,they were divided into the success group(n=43)and the failure group(n=22).Comparative analyses of baseline characteristics,hemodynamics parameters,and laboratory indexes were performed.Independent risk factors were identified via multivariate logistic regression,and predictive performance was evalu-ated using receiver operating characteristic(ROC)curves.Results After treatment,significant improvements were observed in heart rate(HR),central venous pressure,troponin I(TnI),creatine kinase isoenzyme-MB,lactate,serum creatinine,total bili-rubin and aspartate aminotransferase were significantly decreased(P<0.05),alongside increased mean arterial pressure and left ventricular ejection fraction were significantly increased(P<0.05).The APACHE II score,ECMO duration and the incidence of severe hemorrhage in the successful group were significantly lower than those in the failure group(P<0.05).The HR,TnI and lactare in the successful group were significantly lower than those in the failure group(P<0.05).Multivariate analysis showed identified elevated HR(OR=4.544),high TnI(OR=41.918)and high lactate levels(OR=14.073)were independent risk factors for weaning failure(P<0.05).ROC analysis demonstrated robust predictive performance for these variables,with areas under the curve(AUC)of 0.878(95%CI:0.796-0.961),0.951(95%CI:0.879-1.000),and 0.858(95%CI:0.770-0.946)respectively.Conclusion ECMO effectively improve cardiac function of patients after cardiac surgery,and higher HR,TnI,and blood lactate levels are independent risk factors for ECMO weaning failure in patients after cardiac surgery.

Abstract:Extracorporeal circulation(ECC)is a key assistive technology in cardiac surgery,which can temporarily replace the functions of the heart and lungs to maintain the stability of patients'vital signs.However,the application of this technique may also have certain negative effects on the physiological functions of patients,and pulmonary atelectasis is one of the common complications during extracorporeal circulation.Pulmonary atelectasis refers to partial or complete collapse of lung tissue,resulting in limited gas exchange function.It occurs during ECC for complex reasons,including inflammatory stress as well as prolonged hypoventilation.The presence of pulmonary atelectasis not only aggravates the patient's dyspnea,but may also trigger further lung infections and other complications,significantly affecting the postoperative recovery of cardiac surgery patients.Therefore,exploring the occurrence process and mechanism of atelectasis after extracorporeal circulation,as well as measures to prevent and treat atelectasis,is essential to improve the outcome and prognosis of cardiac patients.This article fo-cuses on pulmonary atelectasis after extracorporeal circulation,and aims to provide a systematic review of the current status of its occurrence,the effects on the body,the intrinsic mechanisms of its occurrence,as well as prevention strategies and therapeutic management.

Abstract:Objective To analyze the application of extracorporeal cardiopulmonary support techniques in elderly pa-tients from 2014 to 2024,and to provide practical reference for clinical workers.Methods CiteSpace software was used to visually analyze the literature in the core collection database of Web of Science,including the annual number of publications,institutions,countries,cited journals,high-frequency keywords and keyword clustering.Results 4,452 articles were included in the analysis,and the number of published papers showed an upward trend,especially in 2020,the number of published papers increased abruptly.The most published institutions were Columbia University(96 articles,accounting for 2.16%),followed by Mayo Clinic(86 articles,accounting for 1.93%)and Capital Medical University(81 articles,accounting for 1.82%).The United States published the most articles(1,289 articles,accounting for 28.95%),and China ranked third(569 articles,accounting for 12.78%).Annals of Thoracic Surgery was the most cited journal.The research hotspots focus on the management of extracorpo-real circulation in cardiac surgery,the prevention and management of postoperative complications,and the application of artificial intelligence in extracorporeal cardiopulmonary support techniques.Future research trends include critical care,cohort studies,and disease-related predictions.Conclusion The research on the application of extracorporeal cardiopulmonary support techniques in elderly patients has gradually expanded,and in the future,scholars from various countries can further strengthen international cooper-ation to jointly promote the management and application of extracorporeal cardiopulmonary support techniques in elderly patients,the prevention of postoperative complications and the intelligent development,so as to promote the rehabilitation of elderly patients.

Abstract:Objective To explore the optimal timing of vasopressin initiation for children with complex right heart mal-formation at high risk of vasoplegia after cardiopulmonary bypass:traditional use or early administration?Methods Children aged 1 month to 14 years with complex right heart malformations at high risk of vasoplegia after cardiopulmonary bypass at our pediatric cardiac center from January 1st to December 31st,2023 were prospectively enrolled in this study.The main types of the diseases included moderate to severe Tetralogy of Fallot(TOF),double outlet of the right ventricle with pulmonary stenosis(DORV/PS,TOF type),pulmonary atresia with ventricular septal defect(PAA/VSD).Patients were randomly divided into the early initiation group and the traditional initiation group based on the timing of vasopressin administration.In the early initiation group,vasopressin was given immediately upon return to the intensive care unit(ICU)after completing the systemic vascular re-sistance index(SVRI)measurement.In the traditional initiation group,vasopressin was given only if the following criteria were all met:vasoactive-inotropic score≥20,≥30 mL/kg of isotonic fluid resuscitation administered within 2 hours,and persistent hypotension despite ultrasound evaluation ruling out significant residual anatomical defects and severe ventricular dysfunction(Left Ventricular Ejection Fraction≤40%).The primary clinical outcomes(duration of mechanical ventilation and ICU length of stay)and the related clinical complications were compared between the two groups.Results A total of 169 pediatric patients were included in the final analysis:102 in the early initiation group and 67 in the traditional initiation group.The traditional initiation group exhibited a more pronounced state of vasoplegia prior to vasopressor initiation,with a significantly lower SVRI(899.7±283.1 dyn/s·cm-5·m-2)compared to the early initiation group(1012.7±282.8 dyn/s·cm-5·m-2;P=0.009).The early initiation group had a significantly shorter duration of mechanical ventilation[24(19,43)hours vs.39(21,71)hours,P=0.012]with a reduction of approximately 15 hours.Additionally,the ICU stay was significantly shorter with a reduction of approximate-ly 1.5 days[4(3,7)days vs.5.5(4,13.6)days,P=0.031].In terms of hemodynamics,the early initiation group took less time to achieve target circulation and negative fluid balance.There were no deaths in either group,and there was no significant difference in the incidence of associated complications(arrhythmia,pleural effusion,acute kidney injury and renal replacement therapy),and all patients were successfully discharged.Conclusion Early initiation of vasopressin is superior to traditional use in vaso-plegic shock for pediatric patients with complex right heart malformations after cardiopulmonary bypass.More stable hemody-namics,faster attainment of target circulation and negative fluid balance can be achieved,resulting in shorter duration of ventila-tor support and ICU stay without increasing associated complications.SVRI monitoring can be used as an important reference for the diagnosis of vasoplegia in children and has a good guiding role.

Abstract:With the progressive advancement of cardiac surgery,cardiopulmonary bypass(CPB)technology has become extensively utilized in this field.Acute kidney injury(AKI)is a prevalent complication following cardiac surgery involving CPB,with an incidence rate reaching up to 30%.AKI not only has the potential to progress to chronic kidney disease but also exhibits a high rate of renal replacement therapy utilization,up to 5%,and a mortality rate as high as 50%.Various perioperative factors can elevate the incidence of CPB-related AKI.By identifying and mitigating these perioperative risk factors,the incidence of AKI and perioperative mortality can be significantly reduced.Current prevention and treatment strategies primarily focus on main-taining renal perfusion and vascular volume,avoiding venous congestion,employing balanced salt solutions,and minimizing the duration of CPB exposure.This article aims to review the impact of AKI on postoperative outcomes,its pathogenesis,and the prevention and treatment strategies for AKI following CPB,drawing on recent studies conducted both domestically and interna-tionally.

Abstract:Objective To investigate the hepatorenal protective effects of sivelestat sodium in rats undergoing deep hy-pothermic circulatory arrest(DHCA).Methods Eighteen rats were randomly divided into three groups(n=6 per group):DHCA group,DHCA+ulinastatin group(50000 U/kg),and DHCA+sivelestat sodium group(10 mg/kg).The respective drugs were administered via the reservoir at the beginning of cardiopulmonary bypass(CPB)and during the rewarming stage.Arterial blood gas analysis was performed the following time points:post-anesthesia induction(T1),10 min post-CPB initiation(T2),rewarm-ing(T3),immediately post-CPB(T4),and 4 h post-CPB(T5).Serum levels of interleukin-6(IL-6),IL-10,tumor necrosis factor(TNF)-α,elastase(ELA),creatinine(Cr),blood urea nitrogen(BUN),alanine aminotransferase(ALT),and aspartate aminotrans-ferase(AST)were measured at T2,T4,and T5.Hepatic and renal tissues were examined via optical microscope post-experiment.Results In DHCA rats,IL-6,TNF-α,and ELA levels progressively increased after circulatory recovery.Compared to the DHCA group,both sivelestat sodium and ulinastatin significantly reduced IL-6,TNF-α,and ELA levels while promoting IL-10 release at T5(all P<0.05).The sivelestat sodium group exhibited significantly lower TNF-α(P=0.026)and ELA(P=0.012)levels at T5 than the ulinastatin group.Cr,BUN,AST,and ALT levels in the DHCA group were significantly higher than those in the siveles-tat sodium and ulinastatin groups at T5(all P<0.01).The sivelestat sodium group exhibited lower Cr,AST,ALT,and histopatho-logical scores for hepatic/renal tissues than the ulinastatin group(all P<0.05).Sivelestat sodium attenuated renal tubular injury and reduced hepatocellular vacuolization.Conclusion Sivelestat sodium mitigates DHCA-induced inflammatory responses by suppressing IL-6,TNF-α,and ELA levels while promoting IL-10 elevation.Compared to ulinastatin,it is more effective in miti-gating acute hepatic and renal injury,indicating significant hepatorenal protective effects.

Abstract:This paper elaborates on the fine-grained operational practices in the entire process of perfusion management of McGill University Health Center's cardiac surgery department through clinical observations of cardiopulmonary bypass(CPB)operations.The practices encompass all phases,including preoperative preparation,intraoperative CPB operation,weaning and post-bypass management,as well as postoperative care.This study analyzes the innovative aspects of this center in terms of equipment utilization,technical selection,and team collaboration.The experiences are summarized,and their enlightenment for the field of CPB in China are discussed,aiming to provide practical references and experience for domestic CPB practice.